Nurse Navigators Improve Rate, Timeliness of NGS in Ovarian Cancer

Implementing a nurse navigator program can increase the likelihood that patients with epithelial ovarian cancer receive timely molecular tumor testing, according to a new report.

The study, published in Cancers, also showed that the program led to a higher rate of actionable mutation detection.

Its authors noted that the National Comprehensive Cancer Network recommends germline and somatic tumor testing for all patients with epithelial ovarian cancer, since the identification of certain mutations can help guide treatment decisions. Despite those recommendations, only about 30% of patients undergo genetic testing and only 22.9% of patients undergo molecular testing.

One potential solution to increase testing rates is the implementation of a nurse navigator program, the authors said. Previous research shows that inserting navigators into the treatment process can lead to significant increases in the rate of molecular tumor testing. They therefore implemented a nurse navigator program at the University of Kentucky’s Markey Cancer Center beginning in September 2021. This new study documents the impact of the program.

Young female patient talking to nurse in emergency room: © Monkey Business - stock.adobe.com

The new program called for a nurse navigator to conduct an initial education session with gynecological surgeons to ensure they understood the guidelines and the treatment implications for patients with mutations. Thereafter, the nurse navigator was responsible for interacting with gynecologic oncology tumor boards, recommending and ordering next-generation sequencing (NGS) as appropriate, facilitating NGS testing and reporting, and ensuring results were communicated to necessary parties.

The authors of the study compared the outcomes of 34 patients with epithelial ovarian cancer who were treated at the cancer center before the nurse navigator program with the outcomes of 44 patients who were treated following the program’s implementation.

Before the nurse navigator program, 35.29% of patients were given NGS testing, but after implementation, the rate rose to 77.27%. Before the program, the most common reason patients were not given NGS testing was because targeted panel testing had been ordered. However, after the program was implemented, the most common reason was the cancer’s characteristics, the authors said. They said supplemental training was provided after it was discovered that NGS was inappropriately skipped despite the nurse navigator program.

The nurse navigator also significantly sped up the timetable required for testing. Prior to the program, the total turnaround time for testing was 145.2 days; after nurse navigators were put in charge of coordinating testing, the turnaround time shrunk to an average of 42.8 days.

“On discussion with the nurse navigator, they think their nursing background helped them understand who was a candidate for testing, troubleshoot, and feel confident in recommending testing to the physician if the physician did not recommend testing when indicated,” the authors wrote.

The program ultimately led to a higher rate of actionable mutations being found, the authors said. Two-thirds (67.6%) of patients with recurrent cancers were found to have actionable mutations in the postimplementation period compared with 20.8% before the nurse navigator program. In the frontline setting, there was also a higher rate of actionable mutations, although the difference was less pronounced. The authors said the increase in mutation identification was due to the higher use of NGS, since many of the actionable mutations identified would not have been found using targeted panel testing.

The investigators said their findings confirm that nurse navigators can play an important role in ensuring guidelines are followed and ultimately in improving patient care.

Reference

Rives TA, Pavlik H, Li N, et al. Implementation of nurse navigation improves rate of molecular tumor testing for ovarian cancer in a gynecologic oncology practice. Cancers (Basel). Published online June 15, 2023. doi:10.3390/cancers15123192